Inflammatory bowel disease (IBD) is a resource-intensive condition that is primarily medically managed. Suboptimal drug therapy selection may result in costly adverse health and healthcare outcomes, including maintenance corticosteroid use, hospitalizations, and surgical interventions. There is evidence that anti-tumor necrosis factor antagonists (anti-TNFs) improve the adverse outcomes experienced by younger IBD patients who do not have contraindications to treatment. However, older patients are increasing in prevalence and currently represent ~20% of the 1.4 million Americans with IBD. Recent data suggests that there may be a quality gap in the care of older IBD patients. Anti-TNF utilization and the outcomes experienced by older IBD patients without contraindications to treatment are not known, and there is an even bigger gap in our knowledge about treatment selection in older IBD patients with contraindications to anti-TNF therapy. To ensure high quality of care and appropriate utilization of healthcare resources, it is critically important to examine drug therapy selection and adverse outcomes in the older IBD patients. The proposed research will analyze a cohort of 10,479 Medicare beneficiaries with IBD who are age 65 and above to address the following aims: (1) to examine clinical and socio-demographic predictors of anti-TNF use in older inflammatory bowel disease patients without contraindications to anti-TNF therapy, (2) to compare health and healthcare outcomes (maintenance steroid use, hospitalizations, and surgical interventions) between anti-TNF users and anti-TNF non-users among older IBD patients without contraindications, and (3) to describe common treatment regimens in older IBD patients with contraindications. This research project will provide insight to refine the IBD qualiy measures that were recently released by the Center for Medicare and Medicaid Services.